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Age and Fertility in Atlanta, GA

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With more women working and a global recession that has encouraged people to put off starting families, many women in Atlanta, GA, are waiting until their 30s and 40s before they try to get pregnant. In the United States, about 20 percent of women have their first child after age 35. Unfortunately, research has shown that a woman’s fertility begins to decline in her late 20s (even though her overall chances of becoming pregnant do not start to decline so soon).

After a woman crosses into her 30s, her chances of getting pregnant do start to decline. At age 30 a healthy woman’s chance of getting pregnant naturally each month is approximately 20 percent. By age 40, her chance of conceiving naturally each month drops to approximately 5 percent. About one third of women over 35 have fertility problems. Even though women are taking better care of themselves than in the past, improved health in later life does not offset natural declines in fertility. In addition, older women are more likely to have health problems or biological issues that interfere or affect fertility.

"The best time to get pregnant is a trade-off between the biology of youth, physical maturity of the body and the social wisdom of age," says Sarah L. Berga, MD, a fertility doctor with the Division of Reproductive Endocrinology and Infertility at Emory University School of Medicine. "Probably 25 to 30 years is a good time in modern developed nations, but it might be younger in less well-off countries because undernutrition and social stress and societal upheaval might make us age faster."

Ovarian Reserve: Quality and Quantity of Eggs

Two of the most important things that affect your ability to get pregnant are how many eggs you have left and the quality of these eggs. These together are known as your ovarian reserve.

As a woman ages, the quality and quantity of your eggs significantly deteriorates. The risk of infertility increases because a woman has fewer eggs in her ovaries, and the quality of those eggs is lower than when she was younger. Egg quantity and quality begins to decline in a woman’s late 30s and declines more rapidly in your early 40s.

"Eggs are formed during fetal development and start to decline in number after birth," Dr. Berga says. "Not everyone gets the same number of eggs, and the rate of loss is not identical in all women, but, generally speaking, egg quality and quantity in most women is sufficient for fertility until age 35. In some women, there are eggs that are fertilizable until age 40 to 45, but that is not typical."

A woman’s menstrual cycle and ovulation may also grow increasingly irregular as you get older and can lead to fertility problems.

Chromosomal Problems and Miscarriage

As a woman ages, the eggs remaining in her ovaries also are more likely to develop abnormalities in their chromosomes. These abnormalities lessen the chances of getting pregnant and increase the risk for miscarriage. In fact, at least one half of all miscarriages are due to abnormal chromosomes.

The risk of miscarriage also increases with age. Several studies have found that a woman under 30 years old has a 5 percent chance of having a miscarriage. At 35 to 39 years old, that risk increases to 16 percent, and at 44 to 46 years old, a woman has a 60 percent chance of having a miscarriage.

All these fertility problems tie in together. Older women have an increased risk for miscarriage due to the increase in chromosomal abnormalities in their eggs. In addition, lower quality eggs also raise the risk of chromosomal abnormalities and miscarriage.

IVF Success and Age

Fertility clinics in Atlanta counsel women on their options for fertility treatmentssuch as in vitro fertilization (IVF) or third party reproduction such as egg or embryo donation.

"We have ways of estimating egg count, but it is harder to gauge egg quality," Dr. Berga says. "If a woman has 'poor ovarian reserve' as estimated by ultrasound counting of egg sacs and high FSH levels in the follicular phase, we often recommend donor eggs (oocytes). Poor ovarian reserve is not strictly a function of age, but by age 40, most women are not fertile. By age 50, fertility is vanishingly rare."

If you decided to pursue a fertility treatment such as in vitro fertilization (IVF) with an Atlanta fertility clinic, make sure you understand the success rates for that Atlanta fertility clinic for a woman in your age group. For example, a fertility clinic's success rate for women ages 35 to 37 could be as high as 47 percent, while the success rate for women ages 38 to 40 could be less than 28 percent.

In 2007, Atlanta fertility clinics performed 667 IVF cycles on women under 35, 420 IVF cycles on women ages 35 to 37, 303 IVF cycles on women ages 38 to 40, 107 IVF cycles on women ages 41 to 42, and 50 IVF cycles on women ages 43 to 44.

Because the cost of IVF is rarely covered by insurance, patients may want to weigh the cost against whether they want to try with their own eggs. "The patient has to think about how much money it will cost to have IVF cycle with her own eggs that might not be successful," Dr. Berga says. "Some countries in Europe that pay for IVF will mandate age limits. Individual programs in the USA might also impose age limits but it is not federally mandated."

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